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Unhealthy profits and unwanted hysterectomies: How unregulated private health care in India is risking women’s lives

Unregulated and unaccountable: how the private health care sector in India is putting women’s lives at risk from Oxfam Stories on Vimeo.

Low investment in the public health sector over the years has left India with a fractured and weak health system, unable to meet the needs of the majority of its citizens. Despite efforts in recent years to strengthen public health system – most notably through the National Rural Health Mission – India has one of the lowest levels of government investment in health in the world, with just four countries (Afghanistan, Chad, Guinea, and Myanmar) allocating a smaller share of their overall budget to health. In 2010 government expenditure on health was just 1% of GDP.

The gap left by the public health system combined with a government policy of proactively promoting the private sector has led to the proliferation of private health providers which are unregulated, unaccountable, and out of control. From initially providing 8% of healthcare facilities in 1949, the private sector now accounts for 93% of the hospitals and 85% of doctors. The number of first class private hospitals in India has ballooned in recent years and health tourism has become big business. But such first class service comes with a high price tag and is out of reach for the vast majority of Indians. Instead, poor people become dependent on unqualified drug peddlers, fake doctors (quacks), and unlicensed shops that are largely unregulated. Up to a million unregistered providers are practicing in India today. When the private sector provides health services on behalf of the state it can make it more difficult for citizens to hold their governments to account and to seek justice.Scandals of corruption, unethical practice and human rights violations frequently break out in national newspapers.

War on women: private clinics exploiting poor women for a profit in Rajasthan, Bihar and Chhattisgarh

Under-privileged women from poor communities in India are being left with crippling debts and poor health after being incorrectly advised by private clinics to have unnecessary hysterectomies. These procedures come with huge price tags and high medical risks. In the case of Bihar, Chhattisgarh, and Rajasthan, the government and the private hospitals in some districts have violated the fundamental rights of women and girls in their failures to provide adequate healthcare.
 
In the last few years NGOs and citizens legal networks have attempted to investigate the practices carried out by private clinics. Local NGOs, have filed a series of Right to Information (RTI) petitions which shed light on the high number of hysterectomies being conducted.

In Dausa, a district in the rural interior of Rajasthan, thousands of women have been subjected to hysterectomies by doctors looking to make a profit at their expense. Women from the most discriminated low castes and poor economic backgrounds are being targeted because access to free government healthcare is very limited and illiteracy rates are high. In April 2012, it came to light that four private hospitals in the state’s Dausa district removed the uterus of 226 women last year and earned about Rs 14,000 (around $220) from each patient. One of the women who underwent the surgery explained, “I had a constant stomach ache and they removed by uterus, but the pain did not go. Then I went to Jaipur for treatment and it was found that I was wrongly operated upon.”

Kaushalya, a farm labourer was told she must have a hysterectomy when she visited the clinic with stomach pains. She was charged 30,000 rupees for the operation (around $540). “I went to get medication and have a check up. Because the government hospitals are far away I went to a private clinic. They didn’t check me, they didn’t give me any medication. But they gave me an injection and performed an operation. Even though I only had a tummy ache, they took my uterus out. I still have the same stomach pain I had before. I can’t work, I can’t lift heavy things. Being a poor farmer I don’t have any money, so I had to borrow money. So far I have not even been able to pay just the interest.”

Durga Prasad Saini, an advocate for a local NGO, Akhil Bhartiya Grahak Panchayat, said: “women go to doctors with some sort of abdominal pains and are then advised to undergo a hysterectomy with little diagnosis of the problem. The doctors force them to undergo surgery even though it is not necessary and scare the women in their greed for money.” The NGO filed an RTI (right to information) case to try to get to the bottom of the problem. Only 3 of the 5 clinics provided the information but the results were shocking. Nearly 70 per cent of the women investigated had had their uterus taken out – a large number of the women were under the age of 29, with the youngest being just 18 years old. Despite the fact that complaints have been made to the police and local government, no action has been taken. A special committee, which included leading gynaecologists, public health experts and government officials from Jaipur, was set up over a year ago but to date none of the affected women have been visited by committee members or had their testimonies heard.

Dr Gupta, a medical expert and head of NGO Prayas –who work with Oxfam in India, states in his report that most of the women he interviewed in Rajasthan should not have undergone a hysterectomy, and could have been cured with other treatments. Moreover, he explains that a sonography alone is insufficient to determine a need for hysterectomy, and alternative treatments should always be attempted before this invasive surgery is performed.  Dr Gupta adds “Subjecting women to unethical, unreasonable and unnecessary hysterectomies or caesarean sections for financial gain is a violation of human rights and most awful form of gender based violence. The mass hysterectomies by private hospitals in Dausa are a wicked act, but such malpractices are happening in other areas as well. Prayas is initiating an intensive investigation against such unethical practices.”   Similarly news stories and investigation reports in Chattisgargh and Bihar indicate that unnecessary hysterectomies are common phenomena in rural areas.  Recent reports in the Indian Express exposed that many of the women who seek hysterectomies are not informed about the possible side effects, and think of a hysterectomy as an easy cure to stop menstrual problems. Prayas also found that the doctors are not obtaining informed consent for the hysterectomies.

In Bihar, Prayas found that several women had undergone hysterectomies at private hospitals on the same day as their initial hospital consultations. The women had only had sonographies – no additional tests were performed. As Dr. Gupta makes clear in his report, women should undergo several tests and be offered alternative treatments before a hysterectomy is performed. Many of the women interviewed in Bihar, Chhattisgarh, and Rajasthan were misled into believing that there was an emergency and that the surgery was urgent or made to believe they might get cancer if they did not comply with the doctors’ advice. In most cases the women received no paperwork regarding the surgeries, and many of the BPL (Below Poverty Line) women paid out-of-pocket for the operation. The fact-finding team also found that there is illicit recruiting in the villages, involving “middlemen” who convince women to go to private hospitals. Fraud committed by the private hospitals has also come to light, with physical examinations of former patients revealing that some of the surgeries never took place.

NGOs investigating this case have decided to go the Supreme Court to seek justice for these women and bring the unregulated and unaccountable private providers of healthcare to account.

Action for change: Implementing Universal health coverage

These cases are not ‘stand-alone’ cases of poor health care provision they are in fact symptoms of a failing and weak health care system that needs urgent rectification. Private health care providers need to be regulated and controlled and public health care provision needs to be scaled up and improved. 

In line with the recommendations of a recent High Level Expert Group report, Oxfam along with its partners is calling for the government to prioritise strengthening and scaling up of government health care which is available to all citizens.

Oxfam wants immediate action to regulate private providers and cease further promotion and funding of PPPs until regulation is enforced and quality and equity performance standards are shown to have improved. Private hospitals, nursing homes and other clinical establishments must be properly standardised to improve rationality of care, regulation of fees, and to uphold patient’s rights.

Oxfam calls on international donors to support evidence-based strategies to expand government provision of health care and not promote scaling-up of private-sector health service delivery in low- and middle-income countries. The private sector’s role needs to be clearly defined and regulated and donors should work with governments to strengthen their capacity to regulate existing private health-care providers.

This story has recently featured on BBC News Online - click here for more information

Araddhya Mehtta is an Essential Services Global Campaigner for Oxfam GB

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16 Responses to “Unhealthy profits and unwanted hysterectomies: How unregulated private health care in India is risking women’s lives”

  1. Chandra Pauline Dinakar Ph.D says:

    Thanks to Araddhya Mehtta for highlighting the sordid details and shocking evidences of unregulated private healthcare of women in India. From my research experience and interaction with the BPL (Below Poverty Line) women, I totally agree with the unhealthy profits made by private health-care sectors in India. The best way to abolish this misuse of medical practice is to gather the voices of women affected by the same and create an advocacy for women’s health issues. It’s high time that the role of private sector be clearly defined by immediate governmental support. The government could take into consideration input from a panel of specialists and physicians who see the need and are prepared to advocate for women’s health in India.

  2. Ian MacAuslan says:

    Thanks for this clear warning on this vital topic. It’s extremely worrying that these individuals in positions of power and authority are able to abuse this for profit, and such horrendous cost. Is there evidence from elsewhere of abuses caused by unregulated privatisation of essential services?

  3. Aditya Bahadur says:

    Thanks for this chilling post. Its a scandal that in the ‘world’s largest democracy’ and an ‘emerging super power’ such travesties transpire daily. Interestingly, Aamir Khan touched on some of these issues in an episode of his talk show.

  4. Abhijit Patnaik says:

    The GoI Health budget has increased 3 -fold in the last 7 years, but in many states, there is still a huge shortfall of even basic Public Health Centres. Rajasthan, despite being a ‘High Focus’ state for health initiatives, has an acute shortage of specialists at Public and Community health centres (67% in 2010). The focus needs remain on providing access, and ensuring that awareness of govt schemes like the JSY (which has seen success) goes alon with it.

  5. Sidua Hor says:

    When I watch the BBC TV report on this issue, first I was sad, and then I become very angry that another human being could look into the eyes of poor and a vulnerable woman,and yet condemn her rights to reproduction , and push her to perpetual poverty.This case is is a serious human right abuse at the highest level, criminal and an indictment on the Indian Government. Those behind it must be made face the full rigor of the law, and the India government must ensure that such a thing never happens again. Thanks to Araddhya Mehtta and Oxfam for bringing this to light.

  6. Sidua Hor says:

    When I hear this story at the BBC TV I was sad and then angry. I could just not imagine how another human being can look into the eyes of a poor woman who needed help and then went ahead to condemn her right to reproduction and push her into perpetual poverty for earing a bit of profit. This is a serious human rights abuse and action needs to be taken. The people behind this need to be taken to law. The indictment of the Indian government- it must ensure such a case never occurs again. Private sector needs regulation. Thanks Araddhya from Oxfam for bringing this to light.

  7. SM says:

    Aradhyya thank you for highlighting and researching this issue. As you rightly point out – adequate regulation and adequate legal action against those violating regulation is urgently required. I would be keen to understand one thing – why is it specifically uteruses that were removed? For people who are so poor/unfamiliar – you could do any surgery, remove nothing and charge money for it. Why were women largely under the age of 29 chosen, and is it possible to understand if their operated organs were merely thrown away, or if it was specifically uteruses that were being targetted by a third party linked to the private medical practitioner? Is there evidence of similar operations on other organs of men and women?

    This sort of exploitation is not restricted to poor people only. If you take a poll amongst more affluent women in any urban city – you will notice a shocking rise in the number of caesareans. A simple audit on well known maternity hospitals run by leading healthcare companies will highlight this disturbing trend.

  8. tom says:

    An important post! Private sector firms should be encouraged to contribute immediate. I love this woman author, she is so right.

  9. Pritha says:

    Scary and true and it’s not just the villages, this happens in our “metropolitan” cities too… Thank you Araddhya for bringing it to light and trying to make a change!

  10. MD says:

    Thank you for shedding light on this terrible story, I hope that it will raise awarness and prevent such abuses from happening in the future!

  11. Ghati says:

    Very interesting article indeed as it explores a new angle on how women’s bodies are exploited and abused irreparably for financial gains and how this is cloaked as legitimate, meted out by supposedly “trusted” government and private institutions. Thank you for making us more aware of this form of institutional violence on women.

  12. Amy D says:

    Thanks Araddhya for highlighting this important story. It’s heartbreaking that these women are being exploited for financial gain. And as you poignantly articulated, we need to support evidence-based strategies to expand government provision of health and monitor private sector health delivery much more carefully.

  13. Vidhya says:

    Araddhya thank you for shedding light on such a distressing violation of human rights. The scale at which this is happening is really shocking. The work Prayas is doing to bring doctors who have committed crimes like this to court and seek legal justice for these women is vital and I hope these communities see change. Private health care providers absolutely need to be regulated and held accountable for crimes like this.

  14. Jason says:

    I never leave comments, but this is worth commenting and acting on. Well said, well written. And terrifying.

    Coerced hysterectomies must be just one – if one of the most awful – of a lengthy list of scams that devastate the lives of the most fragile and precarious in our societies. Where government services don’t reach, and private healthcare fills the need, it is scary to think of the degree of manipulation, misinformation and abuse women – and everyone seeking healthcare – must be subject too. Even where government services are there, I wonder if part of the problem is their unreliability and mismanagement which drives people toward private quacks and – as in this case – criminals.

    Much more needs to be done to share these women’s stories, to judge the real scope of private malpractice, and to build a movement that will result not in some half-baked special committee in Jaipur but full scale legislation and complementary work with civil society partners on the ground.

    Thank you Ms. Mehtta.

  15. Isabel says:

    Thank you Araddhya for your research and for this powerful article. The government,in all its different levels,should be taking action in these crimes. As you mentioned, private clinics MUST be regulated and public health care should be every citizen´s right.

  16. Isit a surgery can any body do? Here in my town its done by nursinghome owners under RSBY and for no region even in many nurshinghomes.It requires only more than 40 yrs.Not even a simple biopsy nor even a PAP Cytology .And never a proper medical trial .why not a honest audit .

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Global Health Check is edited by Anna Marriott, Health Policy Advisor for Oxfam GB, and welcomes contributions from different authors. If you would like to write an article for this site or if you have any queries please contact: amarriott@oxfam.org.uk.